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In Response:

With regard to Saritas’s query about leaving a left-to-right shunt of the vertical vein (VV) in selected patients with total anomalous pulmonary venous connection (TAPVC), we disagree. In our study, the VV remained unligated in 3% of the patients in a much earlier time. In the recent era, we have ligated the VV in all patients.1

Cope et al2 suggested that unligated VV was lifesaving in hemodynamically unstable patients with TAPVC. However, Kumar et al3 did not recommend an elective nonligation. They found that patency of the VV would result in severe pulmonary arterial hypertension, and subsequent surgery was usually required. Further histological study may be required to provide evidence.

Leaving a postoperative left-to-right shunt through the VV may not decompress the left atrium because the flow through the VV loads the right ventricle and is then channeled to the …